MDs Urged to Denounce Malpractice Site
Dan Lambe, executive director of Texas Watch, said the site is attempting to scare patients.
“This type of blacklisting runs counter to the Hippocratic Oath to the ethical and moral goals and obligations of medical professionals,’’ Lambe said.
Dr. John Shannon Jones, a radiologist who created the database, could not be reached by The Associated Press for comment Friday. He told The Wall Street Journal that people who sue doctors are going to find their access to health care may be limited.
“That’s a harsh thing to say, but this is a war,’’ said Jones, who has settled two malpractice cases.
I understand it, but I cannot support it.
Posted in Malpractice | 11 Comments »
More on autopsies
March 6th, 2004
My colleague, Stef, wrote this important comment concerning my post on autopsies:
I would fault the NY Times article for failing to reference the autopsy review literature that supports the continued value of autopsies.
At least one or two papers a decade document the surprising effectiveness of autopsies at identifying clinically important (but unsuspected) diagnoses, despite our vaunted diagnostic technology. The most recent was published in JAMA (June, 2003) with Lee Goldman as senior author, reviewing 53 autopsy series articles published since 1966. Despite clearly documented improvements in premortem diagnoses over the decades, their data suggest that a contemporary US institution “could observe a major error rate from 8.4% to 24.4% and a class 1 error rate from 4.1% to 6.7%”, where major errors involve the cause of death, and class 1 errors are such that the patient outcome would have been altered. Maybe some doctors prefer not to know about those missed diagnoses. I don’t know for sure.
As a medical student pathology fellow at the original home of the “Black Crow Award,” (an apocryphal legend about a contest in which a resident won a prize for obtaining the greatest number of autopsies, cf. House of Gods), I conducted about 17 autopsies. I scanned my notes from those cases this evening. Brief summary, of 15 adult autopsied, we found a fair number of unsuspected diagnoses and at least 1 or 2 that appeared materially related to the cause of death but were unsuspected by the physicians caring for the patient, a rate of Type 1 error which appears consistent with the findings of Goldman et al. At that particular hospital, housestaff came to a 20 minute autopsy conference once a week, and we reviewed the findings for them.
Beyond the turning up the occasional unexpected cause of death, the post-mortem examination does help physicians develop a clearer mental picture of the diseases we are called upon to diagnose indirectly, by hints and rumors.
These comments, while true, imply that we can extrapolate from these studies to all hospital deaths. That implicit assumption (which some may make explicitly) does not work.
We must remember that those patients who have autopsies are not representative of all hospital deaths. Most physicians push harder for autopsies when they do not really understand what happened to the patient. Thus, the probability of finding new information is enriched in the autopsied patients.
I favor autopsies in many patients. Usually I do not push for an autopsy in a patient who was terminal (i.e., receiving comfort care, managed by the hospice service). As this represents a large percentage of deaths on our services these days, we will have a lower autopsy rate than 50 years ago. I believe that many patients who had autopsies in the past do not receive them because we make more pre-mortem diagnoses, and thus treat patients appropriately, obviating the need for an autopsy. But then, I cannot prove that.
